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BACKGROUND: The majority of hospitalizations for H1N1 complications have been in people with high-risk comorbidities, including pregnancy. Here we describe the obstetric and critical care treatment of three patients with confirmed H1N1 influenza virus infection complicated by acute respiratory failure.

CASES: We describe the clinical and therapeutic courses of three patients with confirmed H1N1 2009 influenza virus infection complicating singleton, twin, and triplet gestations, each of which were complicated by respiratory failure.

CONCLUSION: These three cases illustrate that a high index of suspicion, prompt treatment, timing and mode of delivery considerations, and interdisciplinary treatment are integral to the care of pregnant patients with H1N1 influenza infections complicated by acute respiratory failure.

Timing and mode of delivery must be considered when managing H1N1 2009 influenza infection leading to respiratory failure during pregnancy.

From the Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, and the Department of Anesthesia, Division of Critical Care Medicine, Stanford University School of Medicine, Stanford, California.